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Wansbeck Care Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 3 September 2018

During a routine inspection

Wansbeck Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Wansbeck Care Home can accommodate up to 40 people. At the time of the inspection there were 39 people living at the service, some of whom were living with a dementia.

We undertook an unannounced focused inspection on 3 September 2018. This meant that the provider did not know we would be visiting. We made a further three announced visits to the home on 7, 12 and 19 September 2018 to complete the inspection. The inspection was prompted following concerns received by the Care Quality Commission (CQC) regarding the management of medicines and concerns relating to pressure care for people. The team inspected the service against two of the five key questions we ask about services: is the service safe and well-led. Issues were identified during the inspection which resulted in the process converting to a comprehensive inspection where all five key areas were examined.

The last comprehensive inspection for the service was carried out in November 2017. At that time the overall rating for the home was good.

At this inspection we found care plans for people were inconsistent in the level of detail recorded and contained contradictory information about the needs of people. This resulted in care plans being confusing and difficult to read. Care staff knew people well and had in-depth knowledge of people’s needs but this was not always reflected in the documentation we reviewed.

There were short falls and omissions with the management of risk. In some instances, risk assessments had been re-written over making them difficult to understand. Some risk assessments were not always detailed for known risks such as pressure care.

Consent to care and treatment was not always sought in line with the Mental Capacity Act 2005 (MCA). The best interest’s decision-making process had been followed for people who lacked capacity to make certain decisions themselves. However, the provider did not have copies of Lasting Power of Attorney (LPA) documentation and could therefore not confirm if relevant people were legally able to act on behalf of people.

Audits were not detailed or robust and had failed to identify the issues found during this inspection. Quality assurance systems had not been effectively implemented to assess, monitor and improve quality at the service.

We saw positive interactions between staff and people. Most people spoke very positively about staff and thought they were kind and caring. There were limited meaningful activities available for people on the days the activity co-ordinator did not work.

Parts of the home were dirty and infection control procedures were not robust.

We received mixed feedback from staff regarding staffing levels and some staff told us they had too much to do and did not have time to spend with people. Safe recruitment procedures were in place however, omissions were noted. Selected training courses the provider had deemed mandatory were not up to date. Some staff told us they did not have time to complete all their work and were behind with paperwork.

The administration of medicines was not consistently safe.

People told us they felt safe. Safeguarding procedures were in place and staff told us about what they would do if they suspected or had concerns about harm being caused to people. However, we found that these procedures were not always followed.

The overall rating for this service has deteriorated from good to requires improvement.

During this inspection, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of the Care Quality Commission Registration Regulations 2009. Notifications of other incidents. You can see what action we have told the provi

Inspection carried out on 28 November 2017

During a routine inspection

This inspection took place on 28 November 2017 and was unannounced. This meant staff and the provider did not know that we would be visiting.

Wansbeck Care Home is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Wansbeck Care Home accommodates up to 40 people across four separate units, each of which have separate adapted facilities. Three of the units specialise in providing care to people living with dementia. At the time of this inspection 39 people were in receipt of care from the service.

At the last inspection in August 2015 we found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Wansbeck Care Home as ‘Good’ overall and ‘Good’ in four domains. We rated the service as ‘Outstanding’ in one domain, namely 'Caring’.

The registered manager had been in post since April 2017 and was registered in September 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found staff remained exceptionally caring and dedicated to ensuring people experienced high quality care. We saw that staff treated people very much as individuals and ensured people continued to follow their preferred routines. We heard how the activity coordinator had worked hard to create a sense of community within the home and developed links with local organisations. Relatives told us that visiting the service was just like popping in to visit people in their own home. People told us that staff made everyone feel welcome and at ease.

We found staff were passionate about providing a vibrant service that gave all equitable choices and experiences. The registered manager and staff were absolutely committed to delivering a service that focused on delivering a personalised service. The team worked collaboratively with people and their relatives to ensure the care provided met each person's needs. However, we discussed with the manager how the assessments could be enhanced, as the provider only supplied pre-assessment templates and therefore there were no documents for staff to use to assess the current position.

We found the registered manager’s leadership style had led to people and staff feeling that they were integral partners in the operation and enhancement of the service. Staff supported people to make decisions for themselves and spoke with people about their wishes and preferences. The registered manager, staff and activity coordinator regularly sought peoples’ views and acted upon their comments.

Each year the activity coordinator organised a relatives meeting in a local restaurant so people could enjoy a meal, network and gain support from others in the same position and in a relaxed atmosphere discuss what improvements could be made to the service. It was evident that people’s voice was heard. Following feedback from people, decisions were made about trips that were scheduled and activities were organised. People were encouraged to discuss events or activities they had always wanted to do and the staff organised these, for example, one person had always wanted to go to a factory that made teddy bears. They told us it had been a ‘dream come true’ when staff surprised them with a trip to a local factory.

Staff received supervision on a monthly basis and they received annual appraisals. Staff were respected within the organisation and were provided with comprehensive training including specialist training. We found there was a culture within the organisation of striving for excellence and assisting all to reach their maximum pot

Inspection carried out on 28 August 2015

During a routine inspection

The inspection took place on 28 August 2015 and was unannounced.

We carried out an inspection on 11 June 2014, where we found the provider was meeting all the regulations we inspected.

Wansbeck Care Home accommodates up to 40 older people, most of whom have dementia related conditions. There were 33 people living at the home at the time of the inspection.

The home was divided into four units which staff referred to as ‘houses.’ Staff explained that these were people’s homes, not units. There were two ‘houses’ on the ground floor, Pine Tree and Sea View and a further two houses on the first floor, Meadow View and River Bank which was an all-male house.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

People and relatives were complimentary about the home. One person said, "This is the best place there is.” A relative said, “My mother prefers here to her own home. It is lovely here.”

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected.

We spent time looking around the premises and saw that the building was generally clean and well maintained. There were no offensive odours in any of the areas we checked. We found the design and decoration of the premises met the needs of people who had dementia related conditions.

We checked medicines management. We noted that medicines administration records were completed accurately. A new room had been identified for the storage of medicines which was more suitable than the present storage arrangements.

Staff told us that training courses were available in safe working practices and which met the specific needs of people who lived there such as dementia care.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. We found that the service had made a number of applications to the local authority to deprive people of their liberty in line with legislation and case law. There was evidence that “decision specific” mental capacity assessments had been completed and best interests decisions made.

People and relatives were complimentary about the meals at the home. We observed that staff supported people with their dietary requirements. Staff who worked at the home were knowledgeable about people’s needs. We observed positive interactions between people and staff. Staff communicated well with people.

People and relatives told us that staff were exceptionally caring. We saw positive interactions between people and staff. Staff spoke with pride about the importance of ensuring people’s needs were held at the forefront of everything they did. The dementia care champion, who wrote to us stated, “I hope you can see from this information how passionate I am and the staff are about helping and supporting all in our home receive the very best care.”

We found that arrangements for people’s social activities were innovative and meet their individual needs. People were supported and enabled to participate in meaningful activities such as baking, gardening and housework. There was a close working relationship with an activities charity.

Staff established positive relationships with families and supported people to maintain relationships when they moved to the home. Gourmet nights were organised for people and their relatives.

People were actively encouraged to give their views and raise concerns or complaints. There was a complaints procedure in place. People and relatives were complimentary about the service.

A number of checks were carried out by the manager. These included checks on health and safety; care plans; the dining experience; infection control and medicines. Action was taken when concerns were highlighted during these checks.

Inspection carried out on 11 June 2014

During an inspection to make sure that the improvements required had been made

We considered our inspection findings in order to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found:

Is the service safe?

The inspection team consisted of three inspectors. The majority of people were unable to communicate with us verbally because of their dementia. Therefore we spoke with their relatives and observed staff practices to determine how care and treatment was provided.

We spoke with six people who were able to communicate verbally and five relatives to find out their opinions. We also consulted with two local authority care managers; a local authority contracts officer, safeguarding officer, dietetic assistant and an infection prevention and control practitioner from the local hospital Trust to find out their views. We also spoke with eight members of staff.

The care home was divided into four smaller areas. Staff explained that these were called “houses” and not units since they were people’s homes. All areas of the care home were safe, clean and well maintained. Staff had started to decorate the home to help orientate and stimulate the senses of people who lived there.

We found that there were now enough domestic staff employed to ensure that relevant standards such as those relating to infection control and the environment were met.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Following a recent court ruling concerning the deprivation of liberty in care settings, the provider may wish to review people’s living arrangements. This could identify circumstances which may amount to a deprivation of liberty according to the revised definition.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

We discovered that equipment was in good working order and was being used correctly. We saw that overlay pressure relieving mattresses used to support pressure care were now correctly positioned over existing mattresses. We observed that some people had adjustable beds in their rooms which could be raised or lowered to help them get in and out of bed safely.

Is the service caring?

We noticed that care workers showed patience and gave encouragement when supporting people. One relative informed us, “My relative doesn’t say much but he smiles at the staff so I know he’s being well looked after.” People looked well cared for.

Is the service responsive?

One relative told us, “The care is good here. They do cater for people with dementia.”

Systems were in place to make sure that lessons were learnt from events such as

accidents, incidents, complaints and concerns. These processes reduced the risk to people and helped the service continually improve.

Is the service well led

A manager was in place who was not currently registered with the Care Quality Commission (CQC). A registered manager is a person who is registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. The previous registered manager had left on the 4 November 2013. This meant that they had been without a manager who was registered with CQC for over seven months. The manager submitted her application to register on the day of our inspection which CQC has received but not yet processed.

People spoke positively about the manager. One person described her as “brilliant”. He also commented, “Out of 100, I’d give it 101. I’ve no complaints.”

We found that a variety of checks were carried out to monitor the quality of the service. These included audits on care plans, health and safety, medication and dining. The regional manager carried out a monthly audit of all systems and procedures at the home. Meetings were held for people and their relatives.

Staff told us they were clear about their roles and responsibilities. They informed us that regular meetings were held and this was confirmed by minutes of meetings. Staff explained that morale had improved within the home. One care worker said, “The morale has totally lifted. The home feels a lot better.”

Inspection carried out on 13 March 2014

During an inspection in response to concerns

We carried out this inspection since we had received information of concern about infection control procedures and the condition of the premises.

We were assisted during our inspection by the manager who had been in post since December 2013. Her name does not appear within this report, because she is not yet registered with the Care Quality Commission.

Some people who lived there were not able to communicate with us verbally because of their condition. We spoke with three people who informed us that staff looked after them well and the home was kept clean.

However, we had concerns about infection control and the cleanliness of the home. In addition, we found that maintenance had not always been carried out in a timely manner. Paint was peeling off in certain areas of the home and some of the ceiling tiles were stained.

We had not planned to look at staffing levels or equipment at the home. However we had concerns about these two essential standards. We considered that there were not enough domestic staff on duty to ensure that relevant standards such as those relating to infection control and the environment were met. We also found that some equipment was used inappropriately, broken or out of use.

We passed our concerns to the local authority contracts and commissioning team, safeguarding team, environmental health and the fire safety officer.

Inspection carried out on 4 September 2013

During a routine inspection

We spoke with 11 people. Most of them were unable to tell us their opinions of the home because of their condition. People indicated that they were happy by smiling and nodding in agreement to us and some people made positive short comments such as, "This is the best home round here.” We spoke with four relatives to find out their opinions of the service. One relative informed us, “I would give them five stars!”

In addition, we spoke with a member of the local authority’s Contracts and Commissioning team who informed us that they did not have any concerns about the service. We also spoke with a member of the NHS challenging behaviour team who described the care as "excellent."

We found before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan and we found that there were enough qualified, skilled and experienced staff to meet people’s needs.

People who used the service and their representatives were asked for their views about the care and treatment and they were acted on. We found that people’s personal records and records which related to staff and the management of the service were fit for purpose.

Inspection carried out on 5 April 2012

During a routine inspection

Due to the nature of their condition a high proportion of people who used the service were unable to express their views verbally on the care they received. The people we spoke with were happy with the food they were eating. They said they were comfortable and that they liked their rooms and the staff.

Relatives who we spoke with made positive comments about the care provided to their family members. One relative commented, “this home provides very good care to my mother. All the staff are wonderful, not just one or two. They are all really caring and nothing is too much trouble.”

We also spoke with staff and observed their practices in order to determine how care and support for people was carried out. We saw that people were comfortable and relaxed.